European Spine Journal最新文献

{"title":"The association between postoperative physical therapy and opioid prescription after posterior lumbar interbody fusion: a retrospective cohort study of United States academic health centers.","authors":"Anthony N Baumann, Robert J Trager, Omkar S Anaspure, Maria LaMontagne, Gordon Preston, Keegan T Conry, Jacob C Hoffmann","doi":"10.1007/s00586-025-08824-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08824-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates whether early postoperative physical therapy (PT) reduces the risk and quantity of opioid prescriptions and the development of opioid-related disorders within the first year after posterior lumbar interbody fusion (PLIF).</p><p><strong>Methods: </strong>We analyzed de-identified U.S. records (TriNetX, Inc.) of opioid-naïve adults with lumbar stenosis who underwent PLIF (2014-2023). Patients were grouped by PT received within two months post-surgery and propensity matched according to variables associated with opioid prescription. Outcomes included the risk ratio (RR) and mean number of opioid prescriptions, along with the incidence and RR of new opioid-related disorders in the first year.</p><p><strong>Results: </strong>After matching, there were 4,031 patients per cohort with adequately matched covariates. Compared to patients in the no postoperative PT cohort, in the first year after primary PLIF, patients in the postoperative PT cohort had a statistically significant lower risk of oral opioid prescription [95% CI] (62.6% versus 73.4%; RR: 0.85 [0.83,0.88]; p < 0.0001), a statistically significant lower mean count of oral opioid prescriptions (2.8 versus 3.7; p < 0.0001), and a statistically significant lower risk of a new diagnosis of an opioid-related disorder (0.72% versus 1.5%; RR: 0.49 [0.32,0.77]; p = 0.0013).</p><p><strong>Conclusion: </strong>Our findings support that postoperative PT after PLIF is associated with a lower risk and reduced number of opioid prescriptions, as well as a decreased risk of opioid-related disorders in the first postoperative year. These results should be validated by prospective trials that also explore the optimal timing of PT and its impact on opioid use and related disorders.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enlargement of the \"cone of economy\" as a biomarker of decompensation in unbalanced adult spinal deformity patients.","authors":"So Kato, Sayaka Fujiwara, Yuki Taniguchi, Hiroyuki Nakarai, Hideki Nakamoto, Koji Nakajima, Kosei Nagata, Junya Miyahara, Michita Noma, Naoto Komatsu, Tomohiro Ushikubo, Toru Ogata, Sakae Tanaka, Yasushi Oshima","doi":"10.1007/s00586-025-08807-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08807-y","url":null,"abstract":"<p><strong>Purpose: </strong>Dubousset et al. proposed that the \"cone of economy\" (COE) in the inverted pendulum model of human standing increases in size significantly in patients with balance impairment. The clinical significance of COE size measured by motion capture as a postural sway index in adult spinal deformity (ASD) patients remains unclear.</p><p><strong>Methods: </strong>Twenty-three patients undergoing ASD surgery in a single institution as well as five healthy male participants were enrolled. The motion-capture of the surface reflection markers above the C7 and S1 spinous processes was performed using infrared cameras, and the most appropriate biomarker of postural stability was determined based on the measurement reliability and the correlations with center of pressure (COP) parameters measured by the force plate. The measurement was repeated 6-months later to examine the postoperative change.</p><p><strong>Results: </strong>Among the various COE parameters, the root mean square (RMS) area of C7 spinous process showed the high measurement reliability with strong correlation with RMS area of COP (ICC (3, k): 0.713, rho = 0.606, p < 0.001). Twelve patients showed their RMS area one standard deviation larger than the mean of healthy participants (23-40 years, 1.8 ± 1.3 cm²). These decompensated patients were older than the others (79.6 vs. 68.2 years old, p = 0.006), and showed the significant reduction in COE size (6.1 vs. 3.2 cm², p = 0.02) 6-months post-operatively.</p><p><strong>Conclusion: </strong>Motion-capture based size measurement of COE was a useful assessment tool for postural stability in ASD patients, showing the significant postoperative reduction in the subgroup of ASD patients with preoperative breakdown of balance compensation mechanisms.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of prolapse to canal ratio (PCR) in cauda equina syndrome outcomes and operative management.","authors":"Asfand Baig Mirza, Feras Fayez, Sami Rashed, Ammal Bibi Shahid, Chaitanya Sharma, Rishabh Suvarna, Amisha Vastani, Ahmed Serag, Ali Nader-Sepahi, Alexander Montgomery, Irfan Malik, Gordan Grahovac, Babak Arvin, Ahmed-Ramadan Sadek","doi":"10.1007/s00586-025-08816-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08816-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the prolapse to canal ratio (PCR) and its long-term impact on outcomes in cauda equina syndrome (CES).</p><p><strong>Methods: </strong>A 5-year retrospective cohort study was conducted across two neurosurgical centers, including adult patients diagnosed with CES due to herniated lumbar discs, treated with laminectomy and/or discectomy, with available radiological data and follow-up. PCR was calculated as the proportion of the disc prolapse cross-sectional area to the total spinal canal area. MRI scans were independently analyzed by two investigators, with random verification by a third. Patient demographics, symptoms, treatment, and follow-up data were also collected.</p><p><strong>Results: </strong>Among 137 patients, cohorts were divided using a PCR cut-off of 0.5. Patients with PCR > 0.5 were significantly more likely to have persistent symptoms at follow-up (OR 3.93, CI 2.25-7.34, p < 0.0001). This risk increased with higher PCR thresholds (> 0.75 and > 0.8). PCR > 0.5 also predicted a greater likelihood of requiring a full laminectomy over minimally invasive approaches (OR 2.14, 95% CI 1.3-3.6, p < 0.005). Lower PCR (< 0.5) was associated with reduced complication rates and shorter hospital stays.</p><p><strong>Conclusions: </strong>PCR is a valuable predictor of persistent pain and functional deficits following CES surgery and could be used to guide patient counseling before surgical intervention.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rivaroxaban versus enoxaparin as thromboprophylaxis in degenerative spine surgery: a randomized blinded non-inferiority study.","authors":"Hamid Reza Khayat Kashani, Sohrab Salimi, Pooyan Alizadeh, Poorya Paryan, Zahra Mohammadi, Naser Kachoueian, Maryam Heli, Nasibeh Ghalandari, Hadi Esmaily","doi":"10.1007/s00586-025-08747-7","DOIUrl":"https://doi.org/10.1007/s00586-025-08747-7","url":null,"abstract":"<p><strong>Purpose: </strong>Venous thromboembolism (VTE) is a significant postoperative complication. The most recommended prophylactic measures involve using the unfractionated heparin, and low molecular weight heparins. Since oral anticoagulants can be administered orally and are cost-effective, they have recently gained attention as a newer intervention. This study aimed to compare the effects of rivaroxaban, and enoxaparin thromboprophylaxis in degenerative spine surgeries.</p><p><strong>Method: </strong>Patients diagnosed with degenerative disc disease, and undergoing spinal surgery were randomly assigned to receive either a subcutaneous injection of 40 mg enoxaparin or 10 mg oral rivaroxaban daily in a non-inferiority trial. The evaluation at two weeks, and three months after surgery included the assessments of VTE and other postoperative complications.</p><p><strong>Result: </strong>According to the study protocol, 220 patients were enrolled in the study and included in the intention-to-treat analysis. However, the results were only available for 204 subjects as per-protocol. Ninety-seven in enoxaparin and 107 in rivaroxaban group. VTE was detected in 4 patients (3.6%) in the enoxaparin group, and 2 patients (1.9%) in the rivaroxaban group (P = 0.154). Reoperation rates were significantly higher in the enoxaparin group (P = 0.008). Moreover, the enoxaparin group experienced a significantly longer hospital stay (P = 0.033). However, other outcomes did not show significant differences between two groups (P > 0.05).</p><p><strong>Conclusion: </strong>This study shows that rivaroxaban effectively prevents VTE incidence in degenerative disc spinal surgeries which is non-inferior to enoxaparin in terms of VTE prophylaxis. Furthermore, the patients in the rivaroxaban group experienced shorter hospital stays and a lower necessity for reoperation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral biportal endoscopic decompression for lumbar spinal stenosis in achondroplasia: a 30-month follow up case report.","authors":"Xiang Liu, Zhihai Su, Dawei Zhang, Guowei Li, Hai Lu","doi":"10.1007/s00586-025-08802-3","DOIUrl":"https://doi.org/10.1007/s00586-025-08802-3","url":null,"abstract":"<p><strong>Introduction: </strong>The present study reported the first case of lumbar spinal stenosis in a patient with achondroplasia, successfully managed through endoscopic decompression.</p><p><strong>Methods: </strong>Case report.</p><p><strong>Case presentation: </strong>A 33-year-old achondroplastic male with a 3-month history of low back pain and right leg radicular symptoms presented to our hospital. Despite conservative treatments, his condition worsened, leading to an inability to stand or walk for more than a minute. Imaging studies revealed multilevel lumbar spinal stenosis, and a selective nerve root block confirmed the L4/5 level as the source of symptoms. He underwent unilateral biportal endoscopic decompressive surgery at L4/5, which involved minimal tissue disruption and preservation of the inner disc nucleus pulposus. Postoperatively, he experienced near-resolution of neurological symptoms and lower back pain, regaining the ability to walk normally within a day and was discharged three days post-surgery.</p><p><strong>Conclusion: </strong>This case report highlights the effectiveness and safety of the unilateral biportal endoscopic technique for lumbar spinal decompression in individuals with achondroplasia, with a successful recovery and no radicular symptoms over a 30-month follow-up period.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Response to functional restoration in non-specific chronic low back pain with Modic type 1 changes.","authors":"Louis Jacob, Agathe Clouzeau, Agnés Ostertag, David Petrover, Jean-François Vergnol, Odile Morchoisne, Léa Pavan, Marion Landais, Thomas Davergne, Augustin Latourte, Pascal Richette, Johann Beaudreuil","doi":"10.1007/s00586-025-08821-0","DOIUrl":"https://doi.org/10.1007/s00586-025-08821-0","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Characterization of bone & cartilage endplate junction in the human lumbar spine: novel ultrastructural insights & association with elemental composition, vascularity and degeneration.","authors":"Amber Salman, Muhammad Kashif Baig, Alejandro A Espinoza Orias, Ana Chee, Dino Samartzis, Uruj Zehra","doi":"10.1007/s00586-025-08784-2","DOIUrl":"https://doi.org/10.1007/s00586-025-08784-2","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of the COVID-19 pandemic on the incidence and mortality of primary spinal tumors in the United States: A SEER analysis.","authors":"Wenbo Zhao, Kai Liu, Xijie Fu, Bo Liu, Wei Liu, Yubo Wang","doi":"10.1007/s00586-025-08800-5","DOIUrl":"https://doi.org/10.1007/s00586-025-08800-5","url":null,"abstract":"<p><strong>Introduction: </strong>The effects of the COVID-19 pandemic on the incidence and mortality of patients with primary spinal tumors remain less explored. We sought to illuminate the influence of the pandemic on the diagnosis and treatment of primary spinal tumors, providing valuable information for improving diagnosis and treatment strategies when facing unprecedented healthcare strains.</p><p><strong>Methods: </strong>Initially, we assessed the demographic characteristics and pathological types of patients with primary spinal tumors who died attributed to COVID-19 during the pandemic (2020-2021). Next, we extracted data on the age-adjusted incidence and mortality rates of primary spinal tumors between 2018 and 2021. The rates for the entire population were retrieved first, followed by stratification based on demographic characteristics and type of pathology. The rates from 2018 to 2019, before the pandemic, served as a reference for comparison with the pandemic period (2020-2021). The SEER 22 Registries database was adopted for this study.</p><p><strong>Results: </strong>In 2020 and 2021, COVID-19 emerged as the leading cause of death among patients with primary spinal tumors. The majority of patients who died attributed to COVID-19 were male, white, and over 60 years of age. Notably, 46.8% (58 out of 124) of them were diagnosed with primary spinal meningiomas. Between the pre-pandemic (2018-2019) and pandemic (2020-2021) periods, the incidence of primary spinal tumors decreased from 1.31 to 1.22 per 100,000 individuals, with a particularly significant decline observed in meningiomas. Moreover, the mortality rates increased from 0.30 to 0.37 per 100,000 individuals during the same period. This increase in mortality was significant among white individuals, those aged ≥ 70 years, and patients with primary spinal meningiomas.</p><p><strong>Conclusions: </strong>Our analysis revealed that COVID-19 emerged as the primary threat to the survival of patients with primary spinal tumors during the pandemic. Compared with pre-pandemic data, we observed a significant decline in the incidence rates and a rise in mortality rates for primary spinal tumors.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between facet tropism and motor dysfunction of the upper limbs in patients with cervical spondylotic amyotrophy: an observational study.","authors":"Yuhang Ji, Kaiwen Chen, Shenyan Gu, Yu Zhu, Feizhou Lyu, Jianyuan Jiang, Xinlei Xia, ChaoJun Zheng","doi":"10.1007/s00586-025-08818-9","DOIUrl":"https://doi.org/10.1007/s00586-025-08818-9","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the frequency of facet tropism (FT) in patients with cervical spondylotic amyotrophy (CSA) and to analyze the correlation between FT and motor dysfunction in CSA.</p><p><strong>Methods: </strong>The side-to-side differences in facet orientation (FO) (≥ 7°) were measured from C3-4 to C7-T1 levels via 3D computed tomography to diagnose FT in 84 CSA patients (proximal- vs. distal-type: 36 vs. 48) and 363 patients with cervical spondylosis (CS). Both the motor unit number index (MUNIX) and Medical Research Council scores were assessed in CSA patients.</p><p><strong>Results: </strong>Compared with CS patients, both CSA patient groups presented a greater frequency of FT at any cervical level in all different planes (axial, sagittal and coronal) (P < 0.05). Furthermore, more proximal-type CSA patients with FT presented axial FT_{S< less-S} (smaller FO on the symptomatic side) at C4-5 level, and more distal-type CSA patients with FT exhibited both axial and sagittal FT_{S< less-S} at C6-7 and C7-T1 levels. In addition, both compound muscle action potential (CMAP) and MUNIX values in proximal-type CSA patients with C4-5 axial FT were lower than those in patients without FT (P < 0.05), and both CMAP and MUNIX values were negatively associated with the side-to-side differences in axial FO at C4-5 and/or C5-6 levels in these patients (P < 0.05).</p><p><strong>Conclusion: </strong>The frequency of FT in CSA patients is greater than that in CS patients. Importantly, axial/sagittal FT may be positively associated with motor dysfunction of upper limbs in CSA patients. Thus, a cautious approach should be taken when treating CSA due to possible comorbid FT.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of type 2 diabetes mellitus on patients undergoing percutaneous endoscopic lumbar discectomy: a retrospective propensity score-matched cohort study.","authors":"Hu Qian, Xiuqian Wang, Zhuo Zhang, Xianxiong Yin, Jun Ao, Jianpu Qin","doi":"10.1007/s00586-025-08808-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08808-x","url":null,"abstract":"<p><strong>Objective: </strong>The effect of Type 2 diabetes mellitus (T2DM) on lumbar disc herniation (LDH) remains controversial. This retrospective cohort study aims to investigate the effect of T2DM on the LDH patients underwent percutaneous endoscopic lumbar discectomy (PELD) throughout pre, peri and post operation.</p><p><strong>Methods: </strong>This study included patients underwent PELD surgery from October 2021 to January 2024. General data including age, gender and body mass index (BMI), hemoglobin, hypertension and coronary heart disease (CHD) were collected. Clinical data including Visual Analogue Scale (VAS) score, surgical time, blood loss, length of hospital stay, recurrence ratio and reoperation ratio were recorded. Imaging data include L1-5 cobb angle, lumbar range of motion (ROM), relative cross-sectional area (CSA) and fat infiltration ratio (FIR) of the paraspinal muscles, abdominal aorta calcification (AAC), disc Pfirrmann grading, herniated disc Michigan State University (MSU) classification and Lee Zoning et al. were measured. Propensity score-matched (PSM) analysis with 1:1 ratio was performed to eliminate the influence of confounding factors using a multi-variable logistic regression model before analysis.</p><p><strong>Results: </strong>728 patients were eligible in this study, and significant difference was detected in age, hypertension and CHD between the T2DM group and Control group. After PSM analysis and matching, 56 pairs of patients generated and were included for further analysis. The patients in the T2DM possessed significantly higher grades of Pfirrmann score and AAC ratio (48.21% vs. 25.00%) than control group. Postoperative VAS of the T2DM group was 2(IQR = 1), which was significantly higher than the Control group, which was 1(IQR = 2). The recurrence and reoperation ratio were 21.43% and 16.07% respectively in the T2DM group, both of which were notably higher than the Control group (5.36% and 1.79%).</p><p><strong>Conclusion: </strong>T2DM may aggravate disc degeneration, impede postoperative symptom relief, and increase recurrence and reoperation rates after PELD.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}